Risk Factors for Chronic Kidney Disease in Newly Diagnosed Hypertensive Subjects in Southeast Nigeria.

BACKGROUND: The aim of this study was to determine the prevalence and associated risk factors for chronic kidney disease (CKD) in newly diagnosed hypertensive patients. MATERIALS AND METHODS: This was a cross-sectional analytical study involving consenting newly diagnosed hypertensive patients who presented at GOPD of Federal Medical Centre, Umuahia, within 0-3 months of diagnosis; and non-hypertensive controls. A semi-structured interviewer- administered questionnaire was used to record the socio-demographic, anthropometric, clinical and bio-chemical characteristics of the respondents. Data were analyzed and compared between the hypertensive group and the non-hypertensive control group. RESULTS: Two hundred and sixty participants took part in the study. However, only 240 completed the study (120 hypertensive, and 120 control participants). After follow-up for 3 months, 42 (35.0%) hypertensive patients had CKD compared to 11 (9.2%) of the non-hypertensive control group. The prevalence of CKD in the hypertensive participants was significantly higher (2=23.27, p<0.001). Multivariate regression analysis of CKD with variables in the hypertensive study group showed an association between CKD and sex (p=0.020), serum triglycerides (p=0.030) as well as serum uric acid (p=0.030). In the control group there was significant association between CKD and sex (p=0.020), serum total cholesterol (p=0.030) as well as serum uric acid (p=0.030). CONCLUSION: The prevalence of CKD among newly diagnosed hypertensives in southeast Nigeria was high. In this group, CKD had an association with sex, serum uric acid and serum triglyceride.

Frequency and risk factors of contrast-induced nephropathy after contrast procedures in a Nigerian tertiary centre.

Contrast-induced nephropathy (CIN) is a significant yet underestimated problem in clinical practice. The increasing use of contrast media in diagnostic and interventional procedures over the last 30 years has resulted in CIN becoming the third leading cause of hospital-acquired acute renal failure (ARF) in developed countries. Despite this, there is still a paucity of data on the incidence of CIN following intravenous contrast media especially in developing countries. The goals of this study were to determine the frequency and risk factors of CIN amongst patients receiving intravenous contrast in a tertiary health institution. This is a hospital-based prospective observational study. One hundred and eighty (180) consenting patients were recruited consecutively over a 6-month period. Venous blood and urine were collected for haematocrit, serum urea, electrolytes and creatinine estimation and urinalysis, before contrast exposure and up to 72 hours post-exposure. The frequency of CIN was 35.9% and one patient required haemodialysis. Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis.

Renal disease in HIV infected patients at University of Benin Teaching Hospital in Nigeria.

BACKGROUND: HIV related renal disease is a common occurrence in patients with HIV infection. It is the third leading cause of end stage renal disease among African-American males between the ages of 20 and 64 years in USA. Renal function impairment has been reported at all stages of HIV infection. The aim of this study is to determine the relationship between severity of renal function impairment and CD4 cell count in HIV infected patients. METHOD: HIV patients presenting at University of Benin Teaching Hospital Benin, City Nigeria from 1(st) January to 30(th) June 2007 were randomly selected and screened for renal functional impairment (RFI). Those with RFI detected by glomerular filtration rate < 60 ml/min/1.73 m(2) or urine protein creatinine ratio 3 200 were stratified into mild, moderate and severe RFI. Forty patients from each stratum and forty HIV infected patients with normal renal functions were recruited as subjects and control respectively. Their clinical and laboratory parameters were evaluated. The data obtained were analysed using SPSS vs 15.0. RESULTS: Of the HIV patients screened, 53.3% had renal functional impairment. of these, 40.2% had mild, 37.7% had moderate and 22.2% had severe impairment in their renal functions respectively Their mean age was 36.0 ± 8.8 years. The CD4 cell count was found to be 309.75 ± 268.71/ul, 188.45 ± 173.12/ul, and 141.10 ± 126.01/ul among subjects with mild, moderate and severe RFI respectively. The CD4 cell count in control group was 319.05 ± 248.41/ul. The difference was statistically significant. (p = <0.001). CD4 cell count had a significant positive correlation with GFR (r = 0.32, p = 0.042). However, there was a negative correlation between CD4 cell count and proteinuria but this was not statistically significant (r = 0.09, p = 0.173). CONCLUSION: Severity of RFI has a positive correlation with degree of immunosuppression in HIV infected patients.

A follow up study of adult nephrotic syndrome in Nigerians: outcome and predictors of endstage renal failure.

Clinical data from 88 patients who presented with the nephrotic syndrome and biopsy proven glomerular disease were analysed to determine the outcome after 8 years of follow up, and to find out the influence of glomerular histology, sex, age, plasma creatinine, creatinine clearance, hypertension, 24-hour urinary protein excretion and microscopic haematuria, on the clinical course and outcome. The results showed that at the end of follow up (8 years), 13 patients (14.8%) had died from renal failure while 24 patients (27.2%) were in chronic renal failure. Persistent renal disease was still present in 29 patients (33.0%). Of the whole group (88), mortality and endstage renal failure were highest amongst patients with focal segmental glomerulosclerosis and membrano-proliferative glomerulonephritis. Male sex, hypertension, impaired plasma creatinine and creatinine clearance in patients from these two groups were associated with progression to chronic renal failure and death from uraemia. At final observation hypertension and microscopic haematuria were marked features of these two histological groups. Prognosis in minimal change nephropathy was quite good with remission occurring in 20 patients (66.6%); persistent renal disease however occurred in 8 patients (26.6%) while 1 patient died from uraemia.

Morbidity and mortality from postpartum hypertension in Nigerian women.

Two hundred and ten patients who were normotensive during pregnancy and labour but developed hypertension during puerperium have been studied. Two groups were identified with this unexpected postpartum hypertension. Although the patients in group A who had earlier onset hypertension were younger and mainly nulliparas, there was no significant difference between both groups with respect to age, serum creatinine, blood urea, blood pressures and presence of abnormal urine sediment at the onset of illness. The incidence of postpartum hypertension was 3.5. per cent; there was remission of hypertension in 8 patients (3.8%) without treatment, recurrence in 17 (8%) while cardiac failure occurred in (5.4%), cerebrovascular accident in 3 (1.4%) and acute oliguric renal failure in 3 (1.4%). Overall mortality was 0.9 per cent while persistent or chronic hypertension was observed in 52 (23.8%) Postpartum hypertension is a definite clinical entity with significant morbidity and mortality. Frequent monitoring of blood pressure in the puerperium is advocated to avoid or reduce cardiovascular, cerebrovascular and renal complications of postpartum hypertension in susceptible women.

Hyperfibrinogenemia and hyperviscous plasma in hypertensive Africans.

Changes in plasma fibrinogen concentrations (PFC) and relative plasma viscosity (RPV) were investigated in 61 Nigerian Africans while they were being treated for essential hypertension. The association of these hemorheologic variables with blood pressure was examined. An analogous study was done on 30 normotensive controls for comparison. The hypertensive patients had, overall, a significant increase in both PFC and RPV (p < 0.001) as compared with control values. However, 44.3% of the hypertensive patients had PFC and RPV values within the defined normal limits. This indicates that in a proportion of the hypertensives, treatment notwithstanding, PFC and RPV are altered only within the physiologic limits. Comparison of PFC and RPV with the degree of hypertension (mild: diastolic blood pressure (DBP) = 90mmHg; moderate: DBP = 91-99mmHg; severe: DBP > or = 100mmHg) showed significant stepwise increases at the moderate and severe levels as compared with the mild level of hypertension. The hyperfibrinogenemia and concomitant hyperviscous plasma observed in the present study could either play a role in the pathogenesis of the hypertension or be the consequence of the hypertension itself, at least in some patients.

Hyperfibrinogenemia and hyperviscous plasma in hypertensive Africans

Changes in plasma fibrinogen concentrations (PFC) and relative plasma viscosity (RPV) were investigated in 61 Nigerian Africans while they were being treated for essential hypertension. The association of these hemorhelogic variables with blood pressure was examined. An analogous study was done on 30 normotensive controls for comparison. The hypertensive patients had, overall, a significant increase in both PFC and RPV (p<0.001) as compared with control values. However, 44.3 percent of the hypertensive patients had PFC and RPV values within the defined normal limits. This indicates that in a proportion of the hypertensive, treatment notwithstanding, PFC and RPV are altered only within the physiologic limits.(AU)

Another look at the nephrotic syndrome in adult Nigerians: pathological and immunological findings.

One hundred and twenty adult Nigerians with the nephrotic syndrome were subjected to similar pathological investigations which included light microscopy and immunoperoxidase study of renal biopsy specimens, serum immunoglobulins and C3c levels. Histological findings showed a wide range of changes with the minimal change type of lesion and proliferative glomerulonephritis accounting each for 33.3 percent of cases studied. Focal changes accounted for 26.3 percent of cases. Glomerular immune deposits were present in 78.6 percent of cases showing non-minimal change glomerular lesions. Serum IgG and IgA were significantly depressed when compared with matched controls (P less than 0.05 and P less than 0.01 respectively) while IgM levels were significantly increased, (P less than 0.001). There was no significant difference between the mean values of serum C3c in the nephrotic group and matched control group. This study shows the high incidence of minimal change nephropathy in our adult population. Although some immunoglobulin (especially IgM) may be identified in occasional glomeruli and cause uncertainty as to the diagnosis, such minor deposition of IgM which is often non specific does not preclude a diagnosis of minimal change nephropathy.

The pattern of proteinuria in congestive cardiac failure due to common heart diseases.

The association between proteinuria and congestive cardiac failure was investigated in patients with hypertensive heart disease, cardiomyopathy, rheumatic heart disease and cor pulmonale. In 33 such patients, proteinuria occurred before and after successful treatment of the cardiac failure. Overall there was a wide variation in the degree of proteinuria amongst the various groups and statistical analysis showed that the distribution of levels of proteinuria and the mean levels of proteinuria were statistically different between any two groups of patients, P = 0.05. Biopsy proven hypertensive nephrosclerosis was found to be a cause of heavy proteinuria which was in the nephrotic range in two such patients. Congestive cardiac failure due to hypertensive heart disease should be included in the differential diagnosis of massive proteinuria even in the absence of renal insufficiency.

The pathological basis of endstage renal disease in Nigerians: experience from Benin City.

A prospective study involving 1,980 patients aimed at defining the pathological basis of endstage (chronic) renal failure in Nigerians was carried out over a six-year period in Benin City, Nigeria. Using information derived from intravenous pyelography, ultrasonography, renal biopsies and autopsies, it was found that 43% of cases of chronic renal failure were due to hypertensive nephrosclerosis, 33% due to obstructive uropathy and 18% due to chronic glomerulonephritis. Chronic atrophic pyelonephritis was a rare finding. The frequency and severity of essential hypertension in Nigerians and their propensity to go into renal failure are similar to what obtains in American blacks. In a society which cannot afford regular dialysis and transplant facilities, there is need for early detection and adequate treatment of essential hypertension.

The rarity of chronic atrophic pyelonephritis in adults Nigerians.

A study was designed to investigate and define the true incidence of chronic atrophic pyelonephritis; its contributing role as a cause of chronic renal failure. The study was designed to investigate and define the true incidence of chronic disease in affected individuals in a hospital based population. We relied on radiological and postmortem histopathological evidences of the disease. The results showed that radiologically detectable unilateral chronic atrophic pyelonephritis was found in only 15 out of 391 intravenous pyelograms performed on patients referred to the renal clinic (3.8 per cent) during the five-year study period; bilateral disease was not found. Histopathological evidence from postmortem studies showed evidence of chronic atrophic pyelonephritis in 12 out of 250 autopsies (4.8%). In a short term follow up of women with unilateral pyelonephritic scars, it was found that antihypertensive treatment and meticulous treatment of urinary tract infection prevented a decline in renal function and the outcome of pregnancy was satisfactory. Chronic atrophic pyelonephritis is a rare disease in adult Nigerians and seems to be a benign disease. It may be indolent and unrecognised in many patients.

Sonographic evaluation of jaundice in Benin-City, Nigeria. A preliminary report.

We performed sonographic evaluations on 14 jaundiced patients over a six months period. Medical jaundice was correctly diagnosed in three, as confirmed by the subsequent clinical course. Sonographic features of surgical jaundice were identified in the remaining 11 cases, five of which were confirmed through either percutaneous transhepatic cholangiography, surgery and pathology or both. Sonography is efficacious in the work-up of jaundice; since the technique is affordable and versatile, it is particularly relevant in developing economies where available resources are limited.

Persistent proteinuria in asymptomatic individuals: renal biopsy studies.

The usefulness of renal biopsy in investigating persistent asymptomatic proteinuria was assessed by a study of 87 out 1245 adults referred for pre-employment medical examination and individuals proposing to take life insurance policies. Out of these 87 persons with initial proteinuria on dipstik test, 25 were found to have persistent asymptomatic proteinuria. Unequivocal abnormalities were seen on light microscopy in 15 of the 25 specimens of renal tissues examined. Focal proliferative glomerulonephritis was the commonest abnormality, being present in 7 out of 15 renal tissues. Overall, 12 persons subsequently developed hypertension. Glomerulonephritis as a cause of asymptomatic proteinuria in the tropics has not been studied in detail; this study suggests that it may be an important cause of renal hypertension. Renal biopsy is an important procedure in evaluating glomerular disease in asymptomatic proteinuria which may subsequently cause hypertensive renal disease.

Peritoneal dialysis in the management of hypertensive acute oliguric renal failure.

Twenty consecutive patients admitted because of severe hypertension and uraemia were offered the benefit of intermittent peritoneal dialysis as an adjunct to hypotensive therapy. The outcome of this modality of treatment showed that despite the adequate control of severe hypertension all the patients remained oliguric and died from uraemia. It is concluded that short term intermittent peritoneal dialysis merely prolongs life for a few days or weeks and does not appear to be the answer to the problem of management of uraemia due to hypertension. An attempt must be made to provide facilities for regular haemodialysis and transplant surgery in developing countries.